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VADM Willard P. Arentzen, MC, USN 
Surgeon General of the Navy 

RADM R.G.W, Williams, Jr., MC, USN 

Deputy Surgeon General 

Director of Public Affairs 

ENS Richard A. Schmidt, USNR 

Managing Editor 

Ellen Casselberry 

Assistant Editor 

Virginia M. Novinski 

Editorial Assistant 
Nancy R. Keesee 

Contributing Editors 

Contributing Editor-in-Chief: CDR C.T. 
Cloutier (MC); Aerospace Medicine: 
CAFT M.G. Webb (MC); Dental Corps: 
CAPT R.D. Ulrey (DC); Education: 
CAPT S.J. Kreider (MC); Fleet Sup- 
port: LCDR J.D. Schweitzer (MSC); 
Gastroenterology: CAPT D.O. Castel! 
(MC); Hospital Corps: HMCM H.A. 
Olszak; legal: LCDR R.E. Broach 
(JAGC); Marine Corps: CAPT D.R. 
Hauler (MC); Medical Service Corps: 
CDR R.L. Surface (MSC); Naval Re- 
serve: CAPT J.N. Rizzi (MC, USN); 
Nephrology: CDR J.D. Wallin (MC); 
Nurse Corps: CAPT P.J. Elsass (NC); 
Occupational Medicine: CAPT G.M. 
Lawton (MC); Preventive Medicine: 
CAPT D.F. Hoeffier (MC); Psychiatry: 
CAPT S.J. Kreider (MC); Research: 
CAPT J.P. Bloom (MC); Submarine 
Medicine: CAPT J.C. Rivera (MC) 



POLICY: U.S. Navy Medicine is an official publication 
of the Navy Medical Department, published by the Bureau 
of Medicine and Surgery, h disseminates to Navy Medical 
Department personnel official and professional information 
relative to medicine, dentistry, and the allied healrh sci- 
ences. Opinions expressed are those of the authors and do 
not necessarily represent the official position of the Depart- 
ment of the Navy, the Bureau of Medicine and Surgery, or 
any other governmental department or agency. Trade 
names are used for identification only and do not represent 
an endorsement by the Department of the Navy or the Bu- 
reau of Medicine and Surgery. Although U.S. Navy Medi- 
cine may cite or extract from directives, official authority for 
action should be obtained from the cited reference. 

DISTRIBUTION: U.S. Nary Medicine is distributed to 
active-duty Medical Department personnel via the Standard 
Navy Distribution List. The following distribution is author- 
ized: one copy for each Medical. Dental. Medical Service 
and Nurse Corps officer; one copy for every 10 enlisted 
Medical Department members. Requests to increase or de- 
crease the number of allotted copies should be forwarded to 
U.S. Navy Medicine via the local command- 

CORRESPONDENCE: All correspondence should be 
addressed to: Editor. U.S. Navy Medicine. Department of 
the Navy, Bureau of Medicine and Surgery (Code 0010). 
Washington. D.C. 20372. Telephone: (Area Code 202) 254- 
4253. 254-4316, 254-4214; Autovon 294-4253, 294-4316. 294 
4214. Contributions from the field are welcome and will be 
published as space permits, subject to editing and possible 
abridgment. 

The issuance of this publication is approved in accordance 
with Department of the Navy Publications and Printing 
Regulations (NAVEXOS P-35). 



U.S.NAVY 




Vol. 69, No. 6 
June 1978 



1 From the Surgeon General 

2 Department Rounds 

'Can Do' Spirit: Alive and Well . . . Life Preserver/Medi-Pac Tested 

5 Notes and Announcements 

7 NAVMED Newsmakers 

8 Features 

Asbestos: A Clear and Present Danger 

11 NOTAP Collects HM Data 

12 The Hospital Corps . . . New Directions, Changing Times 
CDR W.A. Godfrey, MSC, USN 

14 All in the Corpsman's Day 

18 On Duty: Gator Dentistry 
LTD.M. Arendt, DC, USN 

16 Scholars' Scuttlebutt 

Residency Programs: Looking to the Future 

21 Safety 

Emergency Power for Hospitals 

24 Instructions and Directives 

26 Professional 

Alcoholism: Family Illness — Family Therapy 

P. Barnett 

CDRL.C. Ellwood, MC, USN 

29 BUMED Sitrep 



COVER: "I often feel drained at the end of an eight-hour shift," says 
HM3 Ralph Jones of his work in NRMC San Diego's surgical intensive 
care unit. But, he adds, "I can't think of any other place I'd rather be." 
For a look at what the future holds for Jones and his 23,000 fellow corps- 
men, celebrating the Hospital Corps' 80th anniversary this month, see 
page 12. (Photo by Claudie Bob Johnson II) 



NAVMED P-5086 



From the Surgeon General 



The War on Asbestos Disease 



During the past several years, 
leading medical journals have re- 
ported epidemiological findings re- 
lated to asbestos disease in ship- 
yard workers. This group of indus- 
trial workers, and perhaps a signifi- 
cant number of active-duty person- 
nel, suffer an excessive prevalence 
of lung fibrosis and breathing diffi- 
culty, bronchogenic carcinoma, and 
mesothelioma as a result of expo- 
sure to airborne asbestos many 
years earlier. 

You, as Navy health care person- 
nel, have a particularly important 
responsibility to become familiar 
with illness related to asbestos ex- 
posure. You are the most valuable 
resource the Navy has when it 
comes to treating and counseling 
worried individuals, or presenting 
informed opinion on asbestos as a 
public health problem. 

Since World War II, there have 
been continuing Navy efforts to 
carry out a comprehensive control 
program for persons occupational ly 
exposed to asbestos. As knowledge 
of the health consequences of 
asbestos exposure has expanded, so 
have the efforts to prevent asbestos- 
related disease. Present Navy policy 




prohibits the use of asbestos in the 
construction, overhaul, repair, and 
maintenance of naval vessels and 
facilities. In operations where as- 
bestos can become airborne, such 
as in "rip-out" of old pipe insula- 
tion or in building demolition, strict 
environmental control and personal 
protective measures are required. 
All personnel potentially exposed to 
airborne asbestos are required to 
have annual exams, including chest 
X-ray and pulmonary function test- 



ing to detect early signs of asbestos 
disease. 

I have designated the Navy Envi- 
ronmental Health Center as the 
central management point for a 
comprehensive, Navywide medical 
surveillance program for asbestos 
disease. This program includes the 
establishment of a registry to moni- 
tor the incidence and prevalence of 
asbestos disease in Navy civilian 
and military workers, in order that 
effectiveness of both the asbestos 
control program and the screening 
tests for early asbestos disease can 
be evaluated, and that proper fol- 
lowup of all workers who do have 
the disease can be assured. 

With continuing aggressive ef- 
fort, asbestosis and the cancers 
related to it can be eliminated from 
society in the same manner as the 
communicable disease killers of the 
past. I charge you to be an active 
part of that effort. 



jl/? 




W.P. ARENTZEN 

Vice Admiral, Medical Corps 

United States Navy 



Volume 69, June 1978 



Department Rounds 



'Can Do' Spirit: Alive and Well 



Enterprising Navy do-it-your- 
selfers are finding that ingenuity, 
initiative, and a bit of elbow grease 
can go a long way toward solving a 
multitude of practical problems. 
Some cases in point: 

At NRMC Memphis, the Emer- 
gency Medical Service needed an 
extrication vehicle: a tough, four- 
wheel-drive crash truck that could 
cut through rough terrain, as neces- 
sary, to reach automobile accident 
sites, and could carry the large 
special tools required to free trap- 
ped victims from the wreckage. 

The solution to the problem was 
provided by EMS corpsmen, who 
put in long hours to overhaul and 
refurbish an elderly Dodge Power- 
wagon affectionately known as "the 
cracker box." 

The result: a lot of tired muscles 
for the corpsmen, but a sense of 
strong satisfaction — and a vehicle 
perfectly suited to its new use. 

Aboard the USS Guadalcanal, 
nine corpsmen took a good look 
around their medical department 
and decided they could improve 
what they saw. 

Under the lead of HMC David 
McCabe, they pitched in with gusto, 
installing a false overhead, acous- 
tical tile, and new paneling; repaint- 
ing; and hanging an array of pic- 
tures and plaques as a final touch 
for the new decor. 

The area covered was no small 
one — the Guadalcanal's medical de- 
partment includes three wards for 
patients, two operating rooms, an 
X-ray unit, an aviation examining 
room, and a blood bank. But the 
dividends were well worth the ef- 
fort: a considerable increase in pa- 
tient comfort, and quieter, more 



attractive surroundings for both pa- 
tients and medical staff. 

At NKMC Camp Lejeune, CDR 
Cyrus M. Day III (MQ— mulling 
over the difficulties of medical prac- 
tice in a battlefield situation — felt 
that military surgeons should have 
an alternative to the dirt-floored 
operating tent so familiar to viewers 
of M*A*S*H*. 

He sought help from LT Thomas 
W. Gibb, Jr. (CEC), naval regional 
public works officer, and the two 
soon established some exacting cri- 
teria for the proposed new field fa- 
cility. It would be highly mobile. It 
would place no unusual demands on 
existing supply, transportation, and 
maintenance systems; yet it would 

At NRMC Memphis, corpsmen convert 
an aging Dodge Powerwagon for special 
emergency use. Photos by Richard 
Ramsey. 





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U.S. Navy Medicine 



be fully capable of supporting com- 
plex surgical procedures in the 
field. 

Lying in a salvage yard at Lejeune 
were two 1960-model expando-vans 
that had outlived their former use- 
fulness. One man's trash is another 
man's treasure, as Dr. Day and LT 
Gibb quickly realized. With the aid 
of Navy and Marine Corps volun- 
teers, who worked on weekends and 
after hours, the vans were soon 
transformed into an operating room 
and a recovery room on wheels, 
ready for use in the field. 

The prototype facility — desig- 
nated "MOVE," for "mobile op- 
erating van, expandable" — came 
through a series of Field tests with 
flying colors and supported Exercise 
Solid Shield 77 with the 2d Medical 
Battalion. 

The MOVE units have many 
virtues. They can traverse terrain 
that any other tactical vehicle can 
negotiate. They can easily be lifted 
from one truck bed to another, to a 
trailer, to a railroad car, to a barge, 
or to a ship. They can be tucked into 
a C-130 or be lifted from one site to 
another by helicopter. 

The scrubbable, plastic-paneled 
operating room is roomy enough for 
two operating tables, equipment, 
and required staff. All utilities — 
including heating, air-conditioning, 
venting, and electricity — are built 
into the unit and include backup 
systems. The recovery van, con- 
nected with the OR by a collar, 
maintains a constant temperature 
and can accommodate as many as 
18 patients. A third vehicle, used as 
a central supply room, provides 
scrub and sterilization facilities as 
well as space for supply storage. 

The units, with their equipment 
stored inside, can be set up and 
ready to receive patients in just a 
few hours. 

In contrast to the traditional field 
facility, MOVE enables medical 
personnel to treat casualties in a 
controlled environment — a big step 
forward in the battle to save lives. 
It's a pretty important result from 
some simple ingredients: ingenuity, 
initiative, and a bit of elbow grease. 




Patients and staff find life more pleasant in the newly spruced up medical depart- 
ment of the Guadalcanal. 




Surgical team prepares for action in the MOVE unit (mobile operating van, expand- 
able) developed at Camp Lejeune. 



Volume 69, June 1978 



Life Preserver/Medi-Pac Tested 



Under sponsorship of the Navy 
Science Advisory Program, engi- 
neers at the Naval Ocean Systems 
Center, San Diego, are testing a 
life-vest medical pack designed by 
HM3 Larry Gann. 

Gann is assigned to Attack 
Squadron 22, based at the Naval Air 
Station in Lemoore, Calif. During a 
deployment on the USS Coral Sea 
(CV-43), he quickly discovered that 
environmental conditions on the 
flight deck were hampering delivery 
of medical care. The standard "Unit 
One" — a three-pocket bag of medi- 
cal supplies worn over the shoulder 
— was awkward to use in the heavy 
winds, fumes, smoke, rain, and 
darkness the corpsman has to con- 
tend with. Equipment in the Unit 
One was not readily accessible, and 
it was easy to become entangled in 
the bag's strap. Clearly, a better 
design was called for. 

Gann's solution for the problem is 
a modification of the flight-deck life 
jacket to include nine pockets for 
carrying medical equipment and 
supplies. Gann's Medi-Pac is less 
bulky than the Unit One, and its 
pockets enable the corpsman to 
carry inflatable splints, a variety of 
dressings, and other useful items 
that do not fit into the standard 
pack. Also, the corpsman can move 
freely about the flight deck to 
deliver care: the Medi-Pac has no 
dangling straps to trip him up. 

"Gann's Medi-Pac Unit is a sig- 
nificant improvement over the Unit 
One," says CDR C.H. Spence 
(MC), Coral Sea senior medical of- 
ficer. "It might be useful, too, for 
ambulance and rescue crews. Also, 
it might be combined with the flak 
jacket for use by eorpsmen with the 
Fleet Marine Force." 

Fourteen of the Gann Medi-Pacs 
have been fabricated and are now 
being tested aboard 10 Navy ships 
whose types range from carriers to 
submarines. Each of these ships 



will answer an NOSC questionnaire 
on the pack's performance. "From 
those responses," says Richard 
Kataoka, project director for the 
Medi-Pac evaluation, "we will be 
able to determine how useful the 
pack is and find out if there are 
other improvements which could be 



incorporated into the design." 

Sea trials are expected to be com- 
pleted in September, and the subse- 
quent evaluation should take about 
three months. After that, a decision 
will be made on whether the 
Medi-Pac should be produced as a 
standard item for fleet-wide use. 




First Medi-Pac. Pockets for supplies are sewn onto a standard Navy life preserver. 




HM3 Gann, wearing Medi-Pac, discusses its contents with staff members at NAS 
Lemoore. Photos by Steve Hiney 



U.S. Navy Medicine 



Notes & Announcements 




RADM Chrisman 
1906-1978 



IN MEMORIAM 

RADM AUan S. Chrisman, MC, USN (Ret.), former 
deputy surgeon general of the Navy and assistant chief 
of the Bureau of Medicine and Surgery, died 18 April 
1978 in Rockville, Md., at age 71. 

Born in Greensboro, N.C., on 
18 July 1906, RADM Chrisman 
received his Bachelor of Science 
degree from the University of 
North Carolina, and his M.D. 
degree from Harvard Medical 
School in 1930, He was commis- 
sioned a LTJG in the Navy 
Medical Corps on 3 June 1930, 
and interned at Naval Hospital 
Philadelphia, Pa. He then be- 
came a student at the Submarine 
School, New London, Conn., and 
subsequently served in many 
duty assignments associated with 
submarines. From September 
1938 to July 1940, RADM Chris- 
man was medical officer aboard the aircraft carrier USS 
Ranger, on neutrality patrol in the Atlantic. He then 
served a residency in radiology at Naval Hospital, 
Washington, D.C. During World War II, he saw action 
in the South Pacific area and served as medical officer 
at the advanced naval base, Tulagi, Solomon Islands, 
where he was in charge of the Tulagi-Florida Medical 
Facilities. 

In September 1952, RADM Chrisman assumed 
duties as director, Personnel Division, BUMED. On 31 
July 1956, he was ordered to Naval Hospital San Diego, 
Calif., as commanding officer and on 1 Dec 1958 was 
assigned additional duty as Eleventh Naval District 
medical officer. He was promoted to RADM on 1 Aug 
1958. On 24 April 1961, he returned to BUMED as 
deputy and assistant chief and held this position until 
he retired on 1 July 1964. 

RADM Chrisman was a member of the American 
Medical Association, a Diplomate of the American 
Board of Preventive Medicine, and a Fellow of the 
American College of Preventive Medicine. He held the 
Navy Commendation Ribbon, American Defense Ser- 
vice Medal with Fleet Clasp, American Campaign 
Medal, Asiatic-Pacific Campaign Medal with one star, 
World War II Victory Medal, and National Defense 
Service Medal. 

RADM Harold J. Cokely, MC, USN (Ret.), a former 
Navy urologist who served 36 years with the Navy 
Medical Corps, died 6 March 1978 in San Diego, Calif., 
at age 72. 

Borne in Pickering, Mo. , on 9 Feb 1906, Dr. Cokely 



received his Bachelor of Science degree in medicine 
from the University of Missouri, Columbia, Mo., in 
1929, and his M.D. degree from Jefferson Medical Col- 
lege, Philadelphia, Pa., in 1931. He was commissioned 
a LTJG in the Navy Medical Corps on 8 June 1931, and 
interned at Naval Hospital Portsmouth, Va. 

Dr. Cokely began his studies in urology on 29 July 
1940 at the Naval Hospital, Washington, D.C, and con- 
tinued his training at the James Buchanan Brady Foun- 
dation, New York Hospital, New York City. He was 
chief of urology aboard the USS Relief and participated 
in the Gilbert Islands operation, the occupation of 
Kwajalein and Majuro Atolls, and the capture and oc- 
cupation of Saipan. 

From October 1944 to June 1953, Dr. Cokely was 
chief of urology at several naval hospitals. In the next 
few years he served as executive officer at naval hos- 
pitals at Guam, M.I., and St. Albans, N.Y. He then 
became commanding officer of the naval hospitals at 
Key West, Fla. (1957-1959); St. Albans, N.Y. (1959- 
1961), San Diego, Calif. (1961-1964), and Oakland, 
Calif., from which he retired in 1967. 

Dr. Cokely was a Diplomate of the American Board of 
Urology, a Fellow of the American College of Surgeons, 
and a member of the American Urological Association 
and the American Medical Association. He held the 
Navy Commendation Ribbon, American Defense 
Service Medal, American Campaign Medal, Asiatic- 
Pacific Campaign Medal with stars, World War II Vic- 
tory Medal, and National Defense Service Medal. 

CONTINUING MEDICAL EDUCATION CREDIT FOR 
CORRESPONDENCE COURSES 

Selected medical correspondence courses developed 
by the Naval Health Sciences Education and Training 
Command and administered by the Naval School of 
Health Sciences, Bethesda, Md., are now accredited as 
Category I, Continuing Medical Education (CME) activ- 
ities. The Bureau of Medicine and Surgery, as the spon- 
soring organization for these courses, has issued the 
following certification for each of the courses listed be- 
low. 

As an organization accredited for continuing medical education, the 
Bureau of Medicine and Surgery certifies that this continuing medical 
education activity meets the criteria for (insert the number of hours as 
indicated below) credit hours in Category I of the Physician's Recog- 
nition Award of the American Medical Association provided it is used 
and completed as designed. 

• Blood Component Therapy, NAVEDTRA 13121 (12 
credit hours) 

• Control of Communicable Diseases in Man, NAVED- 
TRA 10772-C (30 credit hours) 

• Hospital Environmental Safety, NAVEDTRA 13120 
(30 credit hours) 



Volume 69, June 1978 



• Low Temperature Sanitation and Cold Weather Med- 
icine, NAVEDTRA 10997-C {18 credit hours) 

• Technical Aspects of Occupational Medicine, NAV- 
EDTRA 10700-1 (30 credit hours) 

The Naval School of Health Sciences, Correspond- 
ence Courses Division, will issue a letter to all enrollees 
satisfactorily completing a correspondence course. This 
letter includes the final grade and the date of the com- 
pleted course, and should serve as the physician's 
record of completed continuing medical education 
activities. 

The Council on Medical Education accepts the signed 
statement of the physician on his application for the 
Physician's Recognition Award concerning the kind and 
amount of continuing medical education he has com- 
pleted. In reporting completion of these correspond- 
ence courses, the physician should be sure to give the 
name of the accredited sponsoring organization as the 
Bureau of Medicine and Surgery, Navy Department. 

Requests for course enrollment should be forwarded 
via official channels on NAVEDTRA Form 1550/1, 
(available from training offices or Reserve centers) by 
changing the "to" line, to read: Commanding Officer, 
Naval School of Health Sciences, Correspondence 
Courses Division, National Naval Medical Center, Be- 
thesda, Md. 20014. 

REVISED CORRESPONDENCE COURSES 

Two Navy correspondence courses have been revised 
and are available to Medical Department officers, en- 
listed personnel on active duty, and Reservists in an in- 
active duty status. 

• Low Temperature Sanitation and Cold Weather Med- 
icine (NAVEDTRA 10997-C) consists of three assign- 
ments. The first two sections present general informa- 
tion on construction of cold climate sanitation 
installations and complications in water supply, sewage 
and garbage disposal in low temperature regions. The 
third section provides information on the prevention, 
identification, and treatment of cold injuries. Reservists 
may receive six retirement points upon completion of 
this course. Three texts are used: "Sewerage and 
Sewage Disposal in Cold Regions," Oct 1969; "Water 
Supply in Cold Regions," Jan 1969; and "Cold Injury," 
NAVMED P-5052-29, Sept 1976. 

• Treatment of Chemical Agent Casualties (NAVED- 
TRA 10765-B) contains important techniques for battle- 
field treatment of chemical warfare injuries. It de- 
scribes methods for detecting and identifying chemical 
agents, ways of differentiating casualties from non- 
casualties, and means to protect personnel from chemi- 
cal agents. Physiological and psychological effects of 
various agents and the recommended treatment for 
each are explored in the course. It consists of three as- 
signments, and Reservists may receive six retirement 
points upon its completion. The text used is "Treat- 
ment of Chemical Agent Casualties," NAVMED 
P-5041, May 1974. 



Reservists who have completed earlier versions of 
these courses may receive additional credit toward re- 
tirement for completing the revised editions. The 
courses must be completed while in an inactive duty 
status in order to receive credit toward retirement. 

Requests for enrollment should be forwarded via of- 
ficial channels on NAVEDTRA Form 1550/1 (available 
from training offices or Reserve centers) by changing 
the "to" line, to read: Commanding Officer, Naval 
School of Health Sciences, Correspondence Courses 
Division, National Naval Medical Center, Bethesda, 
Md. 20014. 

CORRESPONDENCE COURSE DISCONTINUED 

The correspondence course for officers, "Adminis- 
trative Aspects of Occupational Medicine" (NAVED- 
TRA 10704), has been discontinued pending the devel- 
opment of new text materials. 

NUCLEAR WEAPONS EFFECTS COURSE 

The Armed Forces Radiobiology Research Institute 
(AFRRI) and the Nuclear Medicine Branch, National 
Naval Medical Center, Bethesda, Md., will co-sponsor 
a Nuclear Weapons Effects course 23-27 Oct 1978 and 
29 Jan-2 Feb 1979. (For a fuller description of the 
course, see April U.S. Navy Medicine.) 

Priority will be given to radiology residents and 
nuclear medicine fellows who require this training as an 
integral part of their specialty programs. Consideration 
will then be given to occupational medicine physicians, 
then to interested medical officers, on a space- available 
basis. The course is planned as an on-going program, 
and has been approved by the American Medical 
Association for Category I Hour-for-Hour Continuing 
Education credit. Students must have a "secret" 
security clearance. 

AFRRI will provide funding for travel and one week's 
per diem allowance to 60 students — 10 Army, 10 Navy, 
and 10 Air Force students in each of the two classes. 

Interested applicants should contact LCDR Jerry A. 
Thomas, Administrative Officer, Nuclear Medicine 
Branch, National Naval Medical Center, Bethesda, Md. 
20014 (Autovon 295-0097 or -0098). 

MANAGEMENT COURSE FOR 
NURSE CORPS OFFICERS 

Nurse Corps officers interested in attending the 
management course leading to a Master of Science 
degree at the Naval Postgraduate School, Monterey, 
Calif., should submit applications in accordance with 
the BUMEDINST 1520.14 series no later than 1 Sept 
1978. Applicants must be Regular Navy, with a mini- 
mum of five years of active duty, and hold a baccalau- 
reate degree. In addition, a minimum of two semesters 
of college-level mathematics is required. Courses in 
differential and integral calculus as well as statistics are 
desirable. 



U.S. Navy Medicine 



IMAVMED Newsmakers 



In 1971, SGT Edward Uldrich ffl 

earned a Bronze Star for bravery in 
action while serving with the 101st 
Army Airborne Division in South 
Vietnam. 

Returning to the States with a 
new life plan, he received his 
diploma in nursing from the Lincoln 
(Nebraska) General Hospital School 
of Nursing in 1974 and entered the 
Navy Nurse Corps in 1975. 

Today, LTJG Uldrich is assigned 
to the Newborn Nursery/Delivery 
Room at NRMC New Orleans, 
where he's happily at home in a 
world, not of infantry, but of 
infants. 

HM3 Connie Estrada, formerly 
senior hospital corpsman in the in- 
tensive care unit at NRMC Camp 
Lejeune, is on her way to a nursing 
career, with help from a $500 
scholarship award from the medical 
center's nursing service. 




LTJG Murray: Riding high 



The scholarship, given annually, 
was established in memory of Com- 
mander Shirley M. Frawley, who 
was a nurse at NRMC Camp 
Lejeune. The award is intended to 
help qualified and dedicated per- 
sons from Camp Lejeune and the 
local area pursue careers in nursing. 

Estrada, who says she has 
dreamed about becoming a nurse 
"ever since I was a little girl," will 
attend the Del Mar College of 
Nursing in Corpus Christi, Texas. 



For LTJG Laurel Murray, a nurse 
on the cardio-thoracic ward at 
NRMC San Diego, jodhpurs and 
riding boots are a second uniform of 
the day. 

Addicted to horseback riding 
since her childhood, Murray never- 
theless turned down offers to ride as 
a "pro" and put herself through 
nursing school instead. After a stint 
in Iran, during which she worked as 
a nurse for the Iranian government, 
she decided to enter the U.S. Navy. 
To occupy time while waiting for her 
commission, she bought her horse, 
"Baw Namack," and embarked on 
breaking and training him for cross- 
country, dressage, and stadium 
competition. 

As a "rookie" competitor last 
year, "Mack" walked off with an 
impressive share of trophies. He 
and his trainer are hard at work on 
plans to increase it this year. 



Marathon running is the loneliest 
athletic event. For HM3 Russell 
Jones, assigned to the Food Service 
at NRMC Philadelphia, training for 
a marathon means running 100 
miles a week and entering any kind 
of track competition he can get his 
legs into. His goal: the 1980 Olym- 
pics. An All-Navy distance runner, 
HM3 Jones was the Navy's best in 
the 5,000 and 10,000 meter runs at 
last year's Intra-Service Track 
Meet. 




LTJG Uldrich: A life transformed 




HM3 Jones: The Navy's best 



Volume 69, June 1978 




Asbestos: A Clear and Present Danger 



Since World War II, the Navy has 
been increasing its medical, engi- 
neering, and control efforts to elim- 
inate the health hazards due to 
asbestos. RADM Henry A. Sparks, 
MC, USN, BUMED Chief of Opera- 
tional Medical Support, is deeply in- 
volved in these efforts. In the fol- 
lowing interview, he expresses 
some of his concerns. 

Admiral Sparks, the news media 
have reported asbestos health prob- 
lems in our Navy shipyards. Could 
yon tell as the scope of the prob- 
lem? 

Asbestos has been an increasing 
medical problem since World War 
II, when it was widely used in the 
shipbuilding industry. Since it takes 




RADM Sparks 



10 to 40 years for some of the effects 
of asbestos to become apparent, it 
was not until the 1960's that the 
serious health consequences of ex- 
posure to asbestos were beginning 
to be understood. These include 
asbestosis, carcinoma of the lung, 
and mesothelioma. 

How has asbestos been used in the 
Navy? 

Asbestos is a fibrous material that 
has been used in pipe covering, 
gaskets, and cloth for engines, 
hulls, and decks. Navy workers are 
exposed to it in the fabrication of 
asbestos materials, their installa- 
tion, and their removal during 
repair and fitting work. Asbestos 
insulation, shingles, and floor tiles 



U.S. Navy Medicine 




Pulmonary function tests in asbestosis (above) show decreased lung volume, no 
obstruction to air flow. Below: Diffuse scarring of asbestosis is apparent in this 
X-ray. Patient also has emphysema. 



have been widely used in building 
construction, and exposure today 
occurs during structural renovation 
and demolition. 

How many Navy and Marine Corps 
personnel are exposed to airborne 
asbestos? 

I'm glad you mentioned airborne 
asbestos, because it is important to 
remember that asbestos isn't dan- 
gerous unless it is inhaled, or possi- 
bly when it is ingested. As many as 
70,000 Navy civilian workers and 
150,000 active-duty personnel may 
presently be at risk of airborne ex- 
posure. These persons deserve 
good industrial hygiene and medical 
surveillance to assure that they are 
not paying an intolerable price for 
doing their jobs. 

Just how dangerous is working 
around asbestos? 

The danger varies, depending upon 
the number of asbestos fibers in the 




breathing air, the size of the fiber 
(short, very fine fibers are the most 
dangerous), and individual suscep- 
tibility. Cigarette smoking greatly 
magnifies the danger of asbestos 
exposure. 

What are the symptoms and signs 
of asbestosis? 

Asbestosis is a chronic, often hid- 
den lung disease in which the symp- 
toms may not begin until a decade 
after first exposure. The earliest 
and most prominent symptom is 
progressive difficulty in breathing 
with physical exertion. These per- 
sons may have dry, crackling 
sounds in the lung bases when ex- 
amined with a stethoscope. With 
advanced disease, there may be 
clubbing of the fingers and cyano- 
sis. The chest X-ray will show dif- 
fuse scarring of the lungs. In the 
cigarette smoker, these findings 
may be accompanied by the changes 
of chronic bronchitis. 

Is asbestosis often diagnosed? 

Probably not often enough. This is a 
very difficult disease to diagnose 
when one does not suspect it. Gen- 
erally, occupational medicine and 
pulmonary specialists use four crite- 
ria: (1) a history of occupational ex- 
posure to airborne asbestos; (2) 
physical signs, such as dry, crack- 
ling "cellophane" rales, finger 
clubbing, or cyanosis; (3) progres- 
sive X-ray changes of lung fibrosis; 
(4) breathing tests that indicate 
lung fibrosis and inability of oxygen 
to get front the lung to the blood. All 
of these criteria should be present. 

Most of as know about lung cancer, 
but what is mesothelioma? 

Mesothelioma is a rare cancer that 
affects the pleura or the perito- 
neum, the inner linings of the chest 
and the abdomen, respectively. It 
can occur in persons not exposed to 
asbestos; however, 85% of reported 
cases have occurred in relation to 
asbestos exposure. The first symp- 
tom of pleural mesothelioma is 



Volume 69, June 1978 




Clubbing of fingers may be seen in pa- 
tients with advanced asbestosis. 

usually chest pain when the patient 
takes deep breaths. This tumor is 
usually diagnosed by chest X-ray 
and needle biopsy. Open biopsy as a 
primary diagnostic technique is not 
recommended, because of the pa- 
tients' impaired lung function. 

"ow is asbestos disease prevented? 

Substitution of non-asbestos mate- 
rials is the primary means of pre- 
vention. In the interim, and during 
the substitution process, good work 
procedures and engineering con- 



trols must be used to control the 
escape of asbestos dust. Dust- 
producing operations may be iso- 
lated, wet down, and ventilated. 
Approved personal protective 
equipment, e.g., respirators, cover- 
alls, and gloves, must be worn. AH 
products containing asbestos should 
be labeled and handled carefully for 
ultimate controlled disposal. 

How can Medical Department per- 
sonnel help? 

You can't eliminate a problem if you 
don't know the critical aspects of 
that problem. Unfortunately, too 
many medical personnel are unin- 
formed about asbestos and its asso- 
ciated health problems. We in 
BUMED are trying to increase 
awareness of this problem in the 
Medical Department. The Navy is 
planning long-range programs that 
will eliminate the hazard. 

First, hospital personnel should 
appreciate the silent, progressive 
nature of asbestos diseases and be 
prepared to detect them early. 

Second, shipyard and shipboard 
Medical Department representa- 
tives should be familiar with dust- 
control measures and personal pro- 



tective equipment and teach work- 
ers how to protect themselves 
against this danger. 

I would like every person in the 
Navy Medical Department to be- 
come familiar with OPNAVINST 
6260.1, which defines the Navy's 
asbestos control program. 

How does smoking relate to dis- 
eases caused by asbestos? 

This is an extremely important 
question. Cigarette smoke irritates 
the lung and damages its ability to 
clear itself of inhaled dust. Asbestos 
workers who smoke are eight times 
as likely to have lung cancer as non- 
smoking workers, and 92 times as 
likely to have lung cancer as non- 
smokers who are not exposed to as- 
bestos. Preliminary data indicates 
that discontinuation of smoking by 
the asbestos worker considerably 
decreases the risk of lung cancer; 
thus it is very important to counsel 
those who have worked with asbes- 
tos to discontinue smoking. Pro- 
grams are being developed to help 
Navy asbestos workers stop smok- 
ing. The relationship between as- 
bestos-related mesothelioma and 
smoking is not certain. 




Safe disposal of asbestos-containing scrap material should protect the unwary from inadvertant exposure. 

10 U.S. Navy Medicine 



NOTAP Collects HM Data 



As reported in the April issue of 
U.S. Navy Medicine, the Navy Oc- 
cupational Task Analysis Program 
(NOTAP) is a Bureau of Naval Per- 
sonnel project to conduct a stand- 
ardized task analysis on all Navy 
enlisted ratings and establish an 
occupational data bank. 

For more than a year, BUPERS 
and BUMED have worked closely to 
include the hospital corpsman rat- 
ing in this Navy-wide project. Many 
ships, Fleet Marine Force units, 
and naval regional medical centers 
have been visited by NOTAP per- 
sonnel for collection of occupational 
data relevant to the Hospital Corps. 
That data will provide the substance 
for task analysis on 13 specialty 
areas associated with hospital 
corps men.* 

Already, more than 4,000 corps- 
men have contributed their time 
and the benefit of their experience 
to this project. Many more will be 
asked to participate by completing 
NOTAP questionnaires designed for 
each of the 13 specialty areas. In 
doing so, hospital corpsmen will be 
able to demonstrate the scope and 
importance of their contribution to 
the Navy Medical Department. 

The questionnaires. Besides the 
information on rate, rating, NEC, 
time in service, etc., usually asked 
for in questionnaires, the NOTAP 
forms give corpsmen an opportunity 
to indicate how they acquired their 



* Afloat/Independent Duty (0000, 8402, 
8407, 8425), Field Medical Service (8404), 
Biomedical Equipment Repair (8477, 8478, 
8479), Radiology (8452), Preventive Medi- 
cine (8432), Ward Corpsmen (0000, 8485). 
Pharmacy (8482) Laboratory (8501-8507). 
Aerospace (840b, 8409), Optician (8463), 
Ocular and Otolaryngology (8444, 8445, 
8446), Operating Room (8483), and Cardio- 
pulmonary (8408). 



rating and NEC, to what degree 
their rating and NEC training are 
supportive of their present job, and 
whether or not they plan to reenlist. 
(Of course, reenlistment remarks 
are not binding in any way.) 

The real substance of the ques- 
tionnaire lies in six sections de- 
signed to pinpoint what people and 
their jobs need for satisfactory coex- 
istence. 

The first of these sections asks 
about job titles. Quite often, job 
titles give rise to misunderstanding, 
among corpsmen themselves and 
among others, about the role and 
responsibility the "label" should 
convey. We believe that the de- 
scription for a job title at one com- 
mand should approximate the de- 
scription for the same title at 
another command. 

The next section concerns col- 
lateral duties and is the place for in- 
dicating memberships on club advi- 
sory boards, on welfare and recrea- 
tion councils, and in similar activi- 
ties. 

The following section, on physical 
and mental job characteristics , is 
designed to determine whether 
such characteristics as sharpness of 
vision or hearing, physical strength, 
ability to concentrate amid distrac- 
tions, etc., are required by the 
corpsman's billet. 

A fourth section, on job satisfac- 
tion, asks such questions as whether 
the corpsman has the opportunity to 
do worthwhile work, whether he can 
see the results of his efforts, and 
what is the quality of his relation- 
ship with others. 

The fifth section deals with equip- 
ment. No doubt this may surprise 
many corpsmen. After all, we deal 
with the human body and not with 
equipment, don't we? But review of 



this section will promptly indicate 
that the hospital corpsman is much 
more equipment oriented than may 
at first be perceived. Granted, *a lot 
of that equipment is simple and 
commonly used, but this part of the 
questionnaire should provide a few 
surprises. 

The final section is the most im- 
portant: It contains task statements 
that pertain to the occupational 
specialty of the participant. While 
some of the questions in this section 
concern ratings skills common to all 
13 specialty areas, a number of the 
questions relate only to the particu- 
lar skills of the respondent. 

In this section of the question- 
naire, corpsmen will have an oppor- 
tunity to give more than a simple 
"yes" or "no" response to various 
statements. As appropriate, they 
can point out such things as the 
time they spend on collateral duties 
and their overall job satisfaction. 
They can signify whether they oper- 
ate or repair equipment, and how 
often they do so in the course of the 
year. 

This section also provides for in- 
dication of the degree of responsi- 
bility the corpsman has for various 
tasks: "1 assist," "I do" (perform), 
"I do and supervise," "I only su- 
pervise." 

The NOTAP project is a huge un- 
dertaking, and its most important 
element is the individual who re- 
sponds to the questionnaire. Com- 
pleting the form takes about the 
same amount of time as taking an 
advancement examination, but this 
time it is not a test. There are no 
scores — no passing or failing 
grades. Rather, it is simply an 
attempt by the Navy to find out how 
work is being done now. 

The Navy is asking you, the ex- 
pert in your job, to tell us what you 
do; how you do it; and how much 
time you spend doing it. 

— HMCM F.A. Burkhart, USN 
BUMED. Code 34 



Volume 69, June 1978 



11 



THE HOSPITAL CORPS... 



CDR Walter A. Godfrey, MSC, USN 



CDR Godfrey has served since 
June 1974 as director of the Hos- 
pital Corps. Next month he will 
leave BUMED to take up a new post 
as director of administrative ser- 
vices at Naval Regional Medical 
Center Corpus Christi, Tex. 

For this issue, which commemo- 
rates the 80th anniversary of the 
Hospital Corps ' establishment, U.S. 
Navy Medicine asked CDR Godfrey 
to comment on some of the prob- 
lems currently confronting the 
Corps — and on what the corpsmati 
of the future can expect from his 
career. — Ed. 



In this issue of U.S. Navy 
Medicine, we honor 80 years of 
outstanding service by dedicated 
members of the Hospital Corps. 

But I believe it is also important 
that we look to the future and at- 
tempt to determine what is in store 
for the only enlisted corps in the 
U.S. military establishment. 

The Hospital Corps has always 
been a changing organization, 
adapting through the years to each 
challenge presented to it. Corpsmen 
are everywhere, doing everything — 
and usually doing it well. I believe 
this will continue to be so, but I 
sense that, over the next decade, 
demands will be made that will 
force more changes in the career 
patterns of hospital corpsmen. 

For decades, hospital corpsmen 
have moved easilv between two 



very separate worlds: that of the 
hospital and that of the operational 
area (aboard ship; with aviation 
units; with the Fleet Marine Force, 
construction battalions, etc.). Today 
the demands of both these worlds 
are becoming yet more pressing. 

I believe that certification of 
specialty personnel (radiology and 
laboratory technologists, inhalation 
therapists, etc.) will soon be a re- 
quirement for JCAH accreditation 
and to meet federal and state laws. 
In time, the process of certification 
will extend to all phases of health 
care delivery — and rightly so, since 
the consumer has the right to de- 
mand proof of expertise. 

The operational forces face a 
unique problem. They not only 
require field medical technicians, 
submarine medicine technicians, 
etc., but must also have specialty 
personnel — and therein lies one of 
our bigger problems. 

Is it good policy to educate and 
train a corpsman for one to two 
years as a specialist, then place him 
in a job where his skills are not fully 
utilized? How many people do we 
lose to civilian life who wish to prac- 
tice their skills but instead see them 
deteriorating, because they must 
serve in a billet where there are no 
full-time demands? 

On the other hand, if these tech- 
nicians are not available when 
needed in the operational forces, 
our military health care delivery 
system is not doing its job. 

I'm sure many quick answers can 
be offered to help solve this prob- 
lem; however, for each action taken. 




CDR Walter A. Godfrey 

a reaction must be considered. 

What about short tours for tech- 
nicians at sea? This creates tremen- 
dous costs in dollars that are not 
available — and in personal turmoil 
for those involved. 

We can produce technicians with 
lesser training in 52 weeks, but this 
would create additional turnover — 
and therefore require more PCS 
dollars — at a time when we face 
continual reduction in both man- 
power and funding. 

Finding the answer to this prob- 
lem of proper utilization of person- 
nel will, I believe, be our most seri- 
ous challenge in the future. 

We have many initiatives at work 



v> 



U.S. Navy Medicine 



. . . New Directions, Changing Times 



to solve this problem: SHORE- 
STAMPS (Shore Requirements and 
Manpower Planning System) to 
determine staffing criteria; NOTAP 
(Navy Occupational Task Analysis 
Program) to analyze our training 
and utilization; an analysis of billet 
distribution; a new workload-meas- 
uring system to determine the 
proper allocation of resources, etc. 
We are in an era of austerity, with 
not enough money or people to do 
all that we may wish to do, or that 
we should do. Fair sharing of the 
shortages must be the rule, as we 
strive to streamline our operations. 
These are some moves that will help 
us do so: 

• I expect our training system to 
change, putting more emphasis on 
"training after schooling." 

• Development of a management 
training course for senior and mas- 
ter chief petty officers will soon be a 
reality. 

• Short-term, in-service "brush 
up" courses and specialty subject 
training by videotape cassettes are 
being planned. 

• A billet review for all senior and 
master chiefs is now under way, 
with the goal of identifying more 
responsible positions, in manage- 
ment areas, that will take advantage 
of their experience and knowledge. 

• Corpsmen will assume greater 
responsibility as "extenders." 

• We will place greater reliance on 
electronics as we learn more about 
this important tool. 

We must learn to properly inte- 
grate all our medical resources and 
distribute them where they are 



needed, at the same time creating 
an atmosphere that attracts young 
men and women to careers as hos- 
pital corpsmen. 

The Navy faces serious problems 
in retention of good people, and the 
Hospital Corps is no exception. 
There are a multitude of reasons for 
our lack of career-motivated person- 
nel: the national economy; per- 
ceived lack of individual recognition 
and upward mobility, etc. Each 
corpsman opting to leave the Navy 
has his or her own reason; however, 
esprit de corps among those of us 
who have chosen to be careerists 
will be the foundation for better re- 
tention. 

The future of the Hospital Corps 
depends upon actions we take in the 
present. We plan the future, and we 
are the example — like it or not — of 
what each new corpsman will imag- 
ine himself or herself to be in the 
years to come. 

We should have a perpetual pride 
in what we do, always striving to do 
it better. We should jealously guard 
our expertise and not let it be 
watered down by those who are not 
willing to perform, or by those who 
refuse to apply themselves. 

AH corpsmen should continually 
evaluate themselves and their fel- 
low corpsmen. Each corpsman 
should strive to be the best at what 
he or she does. This is a peacetime 
Navy: the bands are not playing, 
and our accomplishments are not 
always front-page material. But let 
one bullet be fired in anger and 
within hours hospital corpsmen will 
be called upon to move into the 



breach and put their lives on the 
line. Readiness is imperative. 

Many hospital corpsmen, over 
the past 80 years, have built the fine 
reputation now enjoyed by the 
Corps. We celebrate an anniversary 
this month, and we should honor 
those who came before. Our pride, 
expertise, and readiness to do the 
job at hand must enhance that repu- 
tation. 

Stand up and be counted. Take 
pride in being what you are, and do 
not hesitate to let others know how 
proud you are. There are more than 
200 million people in this country — 
but there are only 23,000 hospital 
corpsmen. 

You are an elite group, a truly 
select group. Work hard to improve 
your technical expertise, but at the 
same time develop those qualities 
that will enhance your rise to posi- 
tions of leadership. 

In a military organization, it is not 
enough to be a technician. In times 
of stress, versatility is invaluable. 
Do not rest upon your academic 
laurels or expertise in your specialty 
— strive for responsibility and broad 
knowledge. Become totally involved 
in your command and committed to 
the Navy as well as to the space in 
which you work. You cannot expect 
to be a leader if you limit your expe- 
rience. 

1 have served with extreme 
pleasure as director of the Hospital 
Corps Division for the past four 
years. To have concentrated my ef- 
forts on serving such an elite, 
special group of people has been an 
honor and a highlight of my career. 



Volume 69, June 1978 



13 



All in the Corpsman's Day 




. . field medical training 



M 



U.S. Navy Medicine 






community impact 




a small, wet crisis 



a moment s respite 



Volume 69, June 1978 



!. r > 



Scholars' Scuttlebutt 



Residency Programs: Looking to the Future 



This recent exchange of letters between a young Re- 
serve medical officer and the commanding officer of 
HSETC touches basic concerns for all those contemplat- 
ing Navy residency training. For that reason, we are 
reprinting it here: 

CAPT Stephen Barchet, MC, USN 

Commanding Officer 

Naval Health Sciences Education & Training Command 

Washington, D,C. 20014 

Dear Sir: 

I am currently nearing the end of a West-Pac cruise 
as squadron medical officer for Desron Twenty-Five, 
Pearl Harbor. 1 have just finished reading the Surgeon 
General's "Special Report, SAC IX" in the November 
1977 issue of U.S. Navy Medicine. It gave me the impe- 
tus to put into words some concerns I've been ponder- 
ing for some time. 

For background, I am serving my first year of active 
duty, following completion of an Ob-Gyn internship 
under Dr. Leon Speroff at the University of Oregon 
Health Sciences Center in Portland. I am a 1976 medi- 
cal school graduate of the University of Washington, 
Seattle, where I was a Navy scholar under the Armed 
Forces Health Professions Scholarship Program for 
three years. Next year I hope to complete my two-year 
tour in Hawaii at the Naval Regional Medical Clinic, 
Pearl Harbor, doing adult medicine and office Gyn. 
This summer I will be applying for selection for a PG-2 
Ob-Gyn residency slot to commence July 1979, which 
brings me to the main issue of my letter. 

In assessing the Navy's Ob-Gyn programs on the 
West Coast as a student on my 45-day clinical clerk- 
ships, in internship interviews, and in discussions with 
residents and staff, I was generally impressed with the 
quality of care and training. I was also dismayed at the 
"writing on the wait" for the near future. As I see it 
currently, because of attrition, the end of the Berry 
Plan era, and the fact that we are in the lag phase of 
reaping benefits from out-of- service trained scholars, 
the West Coast programs will be severely short-staffed 
and "inbred" over the next few years. I realize these 
are speculations based on projections for which I don't 
have statistics, but my concerns are real and can prob- 
ably best be summed up with a few questions. 



1. Will the Navy's Ob-Gyn programs continue their 
past good quality, based on ample staff from diverse 
training backgrounds, dedicated residents, good para- 
medical support, and sufficient clinical material? Or 
will attrition and inbreeding truly jeopardize the quality 
of the programs? 

2. Specifically, can you tell me what the expected or 
predicted staff strengths and backgrounds will be at 
Oakland, San Diego, and Portsmouth for the next 3-4 
years? 

3. Are there plans to cut back on these programs? 

4. Will the scholars currently deferred for out-of- 
service Ob-Gyn training soon be filling staff positions at 
the training hospitals? 

These questions may seem excessive or inappropri- 
ate, I know. No one knows for sure the exact number of 
staff necessary for good training. As well, no one can 
really prove that diversity of background adds signifi- 
cantly to the quality of a program. From school and my 
internship, I am convinced that the best residents were 
those most dedicated to their patients and the quality of 
care they were giving, regardless of who was staffing. 
At the same time one can hardly argue that different 
approaches to problems don't enhance training, and 
that adequate staffing, especially in clinics, isn't 
essential to quality education and quality care. 

I like the Navy. When I applied for a scholarship 
there was no question as to which branch of the service 
I would choose. The Navy has given me a lot: A chance 
to have and raise a family (3 boys) in relative comfort 
during medical school. A change to go to sea, which 
I've always dreamed of. A chance to see how the "real" 
Navy operates. A chance to see half the world I had only 
viewed from National Geographic before. This break in 
my training, which I jestingly tell my fellow wardroom 
peers is my "sabbatical" year, has given me a perspec- 
tive on life that could never have been hoped for if I had 
doggedly continued through my residency. For all of 
this, I am thankful to the Navy. I would like to train in 
the Navy. But when it comes to choosing my training, 
naturally I want the best for myself. I need assurances 
that the Navy will really continue to offer it. Otherwise, 
to be true to myself, I'll have to bide my time fulfilling 
my obligation and then seek training elsewhere. . . . 

I concur with VADM Arentzen when he says "Our 
training programs must be first rate." I also believe 
that you and he are trying all you can to ensure that 



te 



U.S. Navy Medicine 



they are. With this trust in mind, consider my concerns 
and answer them when you are able. 

Respectfully, 

/s/ Richard S. Herdener, LT, MC, USNR 



LT Richard S. Herdener. MC, USNR 
Medical Officer 

Destroyer Squadron Twenty-Five 
FPO San Francisco 96601 

Dear Doctor Herdener: 

It is a pleasure for me to answer your letter of March 
1, 1978, which contained both thoughtful questions and 
a responsible approach to your professional develop- 
ment in the Navy. 

As you very correctly state in your letter, there are 
two important aspects to your professional develop- 
ment. Critical to any physician today is the opportunity 
to seek and obtain full residency education. Critical to 
Navy medical officers is that same opportunity, coupled 
with the absolute necessity to possess knowledge and 
skills upon which our Navy and country so depend. 
Obviously you have taken to heart the importance of 
being a naval medical officer, and you are viewing your 
"sabbatical year" in the clearest of perspectives. 

In answer to your questions as to existing and future 
Navy Ob-Gyn program strengths, my personal views of 
these programs are positive. Staff strength and back- 
ground expertise are sufficient; and I believe strongly 
that our programs will, over the upcoming years, 
remain fully competitive with the bulk of programs 
throughout the country. If I did not so strongly believe 
in the educational value of our Ob-Gyn programs, I 
would not endorse them to you. 1, along with many 
others, am a product of the Navy's educational system 
— and that system, though not perfect, remains valid 
and useful today. 

As a further personal suggestion to you, I strongly 
urge you to seek out, on your own, our Ob-Gyn program 
directors and their staffs and residents. Speak with 
them. See their programs. Judge for yourself the 
products of these programs. I doubt that you will find 
any major disappointments, and I'm convinced you will 
find that Navy Ob-Gyn practices and programs meet 
the test of stringently discriminating evaluations. 

All best regards to you in your searches for personal 
excellence as a Navy Medical Corps officer. If I may be 
of further assistance, do not hesitate to write this com- 
mand, and specifically the Director of Medical Corps 
Programs (Code 4) inHSETC. 

Sincerely, 

/s/ Stephen Barchet, CAPT, MC, USN 



Another 

way to 

save where 
you save. 



Forget the sugar bowl, crack the cookie 
jar, and put away the piggy bank. 

Because, if you're not able to save 
through the Payroll Savings Plan at work, 
there's another way to save with United 
States Savings Bonds. 

It's called the Bond-a-Month Plan and 
it's available at your bank. 

When you sign up, a Bond of any 
denomination you choose is purchased for 
you regularly each month, and the cost is 
deducted from your checking account. 
It's easy and automatic. 

So join the Bond-a-Month Plan. It's a 
good way to take advantage of a good old 
deal. U.S. Savings Bonds. 



Series E Bonds pay 6% interest when held to 
maturity of 5 years (4 1 / 2 % the first year). Interest 
is not subject to state or local income taxes, and 
federal tax may be deferred until redemption. 




Take 
. stock 
ln^merica. 



200 vears at the same location. 



^wl A piMii service ol 
^JJj^j and Tfte Adkertism 



this publication 
Advertising Council 



Volume 69, June 1978 



17 




LT Douglas M. Arendt, DC, USIM 



What's it like to be a rookie den- 
tal officer on your first sea 
deployment? 
For me, it's been an eye-opening 
experience, and certain features of 
it have caught me by surprise. It's 
my hope that the following tips from 
a "rookie gator" will be helpful to 
other dental officers on their first 
shipboard assignments. 

Procuring patients. Where do 
your patients come from? My first 
response was "From the ship, of 
course," but this is not necessarily 
true. I soon found that men on other 
ships in the squadron or in the vicin- 
ity had the same dental needs as the 



LT Arendt is dental officer aboard the USS 
Inchon (LPH-J2), FPO New York 09501. 



men on my ship, the USS Inchon 
(LPH-12). 

Patients originate from a variety 
of ships that include cruisers, frig- 
ates, destroyers, oilers, and supply 
ships. Dental med-evacs can come 
from almost anywhere. Most ships 
don't have dental officers but do 
have a corpsman trained to adminis- 
ter emergency dental care and 
triage other cases to a dental offi- 
cer. It is your professional responsi- 
bility to seek out these ships and 
offer help. 

My plan of action evolved after I 
had gained experience in several 
training anchorages. The Inchon 
communicates with non-dental- 
staffed ships by message, seeking 
dental patients in acute pain or in 
need of care to forestall a future 



dental emergency. The key to iden- 
tifying these patients is the triage 
and recordkeeping by the independ- 
ent-duty corpsman. 

When other ships in your vicinity 
know you're there, you may initially 
have a flood of patients; however, 
once the backlog has been treated, 
the referral system functions more 
efficiently. Getting advance notice 
of patients' arrival gives you better 
control of scheduling and reduces 
inconvenience to your immediate 
patient pool and to patients from 
other ships. 

Transportation between ships can 
usually be provided by boat or heli- 
copter, using mail runs or adminis- 
tration boats throughout the day. 
Visiting patients may arrive in 
groups, during the morning, after- 



18 



U.S. Navy Medicine 



noon, or evening session, and read- 
ing material and meals should be 
provided for them as necessary. 

No matter how hard you try to 
plan ahead, don't be surprised if 
you are faced with a number of un- 
expected dental casualties. On sev- 
eral occasions you will be chal- 
lenged by patients requiring far 
more treatment than you can com- 
plete in one sitting. 

A sincere "thank you" and a pa- 
tient's renewed interest in oral 
health can be very gratifying. It is 
unfortunate that you cannot provide 
total care to everyone, but this is 
impossible and is not within your 
mission, since you are limited by 
budgets, supplies and man-hours. 

Appointments. Appointment 
books are great, but the first thing 
you'll need on a ship is a big eraser. 
Flexibility is a key word! Scheduling 
must be worked around general 
quarters, under way replenish- 
ments, working parties, drills, 
rough seas, lack of water, planning 
board for training meetings, depart- 
ment head meetings, narcotics in- 
ventories, and other tasks. 

It is best to keep your appoint- 
ment book in pencil and record in- 
formation on names, rates, divi- 
sions, and telephone numbers (at 
least two per man). There is nothing 
more frustrating than playing hide- 
and-seek below decks, trying to find 
your patient. 

During any major ship evolution, 
manpower is the number one prior- 
ity, and as a result your patients 
may fail to show up or may cancel 
their appointments when their ser- 
vices are needed elsewhere. Try to 
maintain a standby list of easy-to- 
Iocate patients who can be substi- 
tuted at short notice. 

The hardest lesson for me was 
that while "Dental" is indeed an 
important part of the ship, at times 
it may have to take a back seat to 
the ship's primary functions or mis- 
sions. No matter how you vary 
scheduling techniques, just when 
you think you have the answers, 
you're back to the drawing board. 
Remain flexible, and never give up! 

Hours. Saturdays, Sundays and 




Dr. Arendl (left) and DT3 M. Cortney work on patient aboard USS Inchon. 



evenings can fairly and effectively 
be used to treat patients. I found 
Saturdays to be a good day for spe- 
cialty care, and used evenings and 
Sundays as a buffer for missed ap- 
pointments or overflow. Evenings 
can also be used for a maximum of 
three prophylactic appointments. 
This system is a great way to keep 
up-to-date on charts, X-rays, and 
your patients; however, it's easy to 
overwork your technicians, so when 



they work extra hours, give them a 
little slack. Compensatory time 
away from the chair for an hour or 
so in the day, if you can spare them, 
gives them the opportunity to ac- 
complish other work or personal 
errands. We alternated the nights 
that the technicians handled pro- 
phylactic appointments, and didn't 
schedule appointments for the same 
night the technicians had to clean 
up the Dental Clinic. 



Volume 69, June 1978 



19 



Remember, everyone must work 
together in small spaces for long 
hours. Be reasonable and invite in- 
put from your staff. The techni- 
cians' advice, experience, and pref- 
erences should be solicited; you'll 
be pleasantly surprised by the as- 
sistance they can provide. 

Supplies. You should plan to be 
well stocked prior to deployment to 
avoid running short, since you may 
be surprised by your patient load. 

Additional supplies can be hard 
to obtain while you are deployed, 
but there are a variety of sources. 
Some supplies, especially surgical 
consumables, are carried in the 
Consolidated Afloat Requisitioning 
Guide Overseas, and these can be 
obtained from under-way and verti- 
cal replenishments, with the assist- 
ance of your ship's supply officer. 

When you're in a major port 
where an NSA facility is located, 
there will probably be a dental 
shore facility. Make a protocol visit 
to the shore station and let them 
know you need help. If sufficient 
supplies are on hand, you may be 
able to purchase needed items. If 
not, ask the shore dental clinic to act 
as liaison for you with the dental 
supply people. (All naval regional 
dental centers have fleet liaison of- 
ficers.) 

Last but not least, keep an inven- 
tory of your supplies on hand. De- 
velop a good rapport with the ship's 
supply officer and his staff, and tell 
him your plan of action and goals for 
the next year. Project your neces- 
sary stock replenishments, using 
your DD-477 and deployment sched- 
ule, and create a "wish list" of 
items you realistically need for the 
future. You should justify your 
operating target with a record of 
work already accomplished. 

An efficient supply system re- 
quires a central location for sup- 
plies, a supply inventory tickler sys- 
tem, and the use of supply-request 
chits within your clinic. Excess sup- 
plies in the clinic workspace clutter 
the clinic, indicate an inefficient 
technician, and preclude an up-to- 
date inventory. Operate the clinic as 
you would a large facility, having 



the chairside technician prepare 
chits for future needs. This reduces 
waste, keeps the proper supplies on 
hand, and enhances security. 

Embarked personnel. In the Ga- 
tor Navy, we often have an embark- 
ed Dental Battalion Landing Team 
doctor who is responsible for dental 
care of the squadron's embarked 
Marines. This puts the ship's dental 
officer and the BLT dentist in a uni- 
que position: two kings in one 
castle. 




DT2 A. Hanshaw monitors Dental De- 
partment budget. 

As the ship's dental officer, you 
are responsible for the overall 
administrative function of the clinic. 
Duties, watches, cleanup, and in- 
spections should be shared by the 
embarked staff. However, you must 
work with the BLT dentist, treating 
him as an equal — a fellow company 
commander — and including him in 
decisions, especially when they 
directly affect him or his assigned 
technician. Put yourself in his posi- 
tion, and respect him as a co-leader. 

Liberty. When you get to a liberty 
port, go! You should make sure that 
your department is covered by a 
duty technician and schedule at 
least one sick call per day. 

Take the initiative: at liberty call 
get on a bus or a train, or just walk, 



and discover these cities you may 
never see again. Opportunities are 
endless for travel. The ship gener- 
ally sponsors short tours, and the 
prices are more than reasonable. 
We on the Inchon have been able to 
see most of Sicily, all the major 
Italian ports, parts of Germany, 
Palma, and several Spanish cities. 
The point here is to work hard at sea 
and share the wealth during liberty 
hours while you're in port. 

Personnel and spaces. It's to be 
hoped that you will be blessed with 
at least two hard-working, well- 
rounded dental technicians. They 
will need to muster every bit of fore- 
sight they have. They must be 
jacks-of-all-trades, since they will 
be involved in chairside, adminis- 
trative, repair, and preventive 
duties. 

The spaces aboard the Inchon 
consist of two dental operatories, an 
administration area, a combination 
X-ray/darkroom/storage area, and 
a lab area where minor prosthetic 
repairs and sterilization procedures 
are carried out. 

I have mentioned just a few of the 
professional challenges you'll 
face. If you can build from these 
suggestions and survive the idio- 
syncrasies of shipboard life — such 
as no water after you've sudsed up 
in the shower, hot water but no cold 
water, or working in the dark — you 
will enjoy sea duty. Perhaps the 
most important thing to learn is to 
be patient and flexible, and to try to 
anticipate problems before they 
happen. 

Although dentistry at sea is chal- 
lenging, hard work, you may won- 
der if anyone really notices your 
efforts (I think they do). Overall, 
you'll probably have a feeling of 
great satisfaction when you've 
mastered each hurdle without quit- 
ting and experienced the exhilara- 
tion of a job well done. And one of 
your finest moments will come 
when you're on your way home to 
your family and you realize how 
much you've accomplished since 
graduation from dental school. 
Good luck! 



20 



U.S. Navy Medicine 



Safety 



Emergency Power for Hospitals 



W. 



ith growing dependence on new electrical and elec- 
tronic apparatus for health care delivery, reliable elec- 
trical power has become vital. 

Interruption of normal electrical service in health 
care facilities may be caused by catastrophes, such as 
fires, storms, floods, earthquakes, or explosions; by 
failure of systems, such as a grid failure; or by incidents 
within the facility. 

On such occasions, normal service may not be res- 
tored for hours — or even for days. Thus, emergency 
backup systems must be provided so that continuity of 
vital services is preserved at all times, and internal 
disruption is limited. 

ESSENTIAL ELECTRICAL SYSTEMS 

National Fire Protection Association (NFPA) Stand- 
ard 76A, "Essential Electrical Systems for Health Care 
Facilities," describes performance and maintenance 
requirements for electrical systems in those portions of 
health care facilities where power outages would jeop- 
ardize the safety of patients and other occupants. This 
standard, covering the central electrical systems for 
hospitals, nursing homes, residential custodial care 
facilities, etc., has been coordinated with the National 
Electrical Code, NFPA Standard 70, 1978, and the Life 
Safety Code, NFPA Standard 101, 1976. 

The "Essential Electrical Systems" for hospitals are 
the Emergency System and the Equipment System — 
two separate systems capable of supplying the limited 
lighting and power service required for life safety and 
effective hospital operation when normal electrical 
service is interrupted for any reason. 

NFPA 76A specifies that the Emergency System is to 
be limited to circuits essential to life safety and critical 
patient care. (These circuits are designated the "Life 
Safety Branch" and the "Critical Branch.") The Equip- 
ment System is to supply major electrical equipment 
necessary for patient care and basic hospital operation. 

The Emergency System is to be arranged so that, in 
the event of failure of the normal source of power, an 
alternate power source is connected within 10 seconds 
to the Emergency System loads. Time-delayed switch- 
ing devices (either automatic or manual) are used to 
supply the Equipment System loads. 



CDR John P. Swope, MC, USN, BUMED, Code 416 



EMERGENCY SYSTEM 

Wiring for each branch of the Emergency System 
shall be separate and independent from all other wiring 
and equipment. Receptacles being supplied from the 
Emergency System shall be a distinct color or marked 
so as to be readily identifiable. 

Life Safety Branch. The loads connected to the Life 
Safety Branch are: 

• Illumination of the means of egress, exit signs, and 
exit directions (required by NFPA Standard 101, Life 
Safety Code, 1976). 

• Alarms and alternate systems, including fire alarms, 
alarms required for medical gas systems, hospital com- 
munication systems, task illumination, and selected 
receptacles at the generator set locations. 

No functions other than those listed here shall be 
connected to the Life Safety Branch. 

Critical Branch. The loads connected to the Critical 
Branch shall supply power for task illumination and for 
selected receptacles serving the following areas and 
functions: 

• Anesthetizing locations (task illumination only). 

• The Isolated Power System (IPS), required in anes- 
thetizing locations in the special environment. 

• Patient-care areas — task illumination and selected 
receptacles in infant nurseries, medication prep areas, 
pharmacy, dispensary, selected acute nursing areas, 
psychiatric bed areas (task illumination only), ward 
prep rooms, nursing stations (unless adequately lighted 
by corridor luminaries). 

• Additional specialized patient-care task illumination 
and selected receptacles where needed. 

• Nurse call systems. 

• Bone, blood and tissue banks. 

• Telephone equipment room and closets. 

• Task illumination, receptacles, and special power cir- 
cuits selected for: acute care beds (selected), angio- 
graphic laboratory, cardiac catheterization laboratory, 
coronary care units, hemodialysis rooms or areas, 
emergency care treatment rooms or areas (selected), 
human physiology laboratory, intensive care unit, post- 
op recovery rooms (selected). 

• Additional task illumination receptacles and special 
power circuits needed for effective hospital operation. 



Volume 69, June 1978 



21 



NFPA 76 A permits the Critical Branch to be subdi- 
vided into two or more branches. 

EQUIPMENT SYSTEM 

The Equipment System shall be installed and con- 
nected to the alternate power source so that equipment 
described in the following paragraph is automatically 
restored to operation within an appropriate time inter- 
val following the energizing of the Emergency System. 
This arrangement shall also provide for the subsequent 
manual connection of equipment. 

Equipment for time-delayed automatic connection 
includes: 

• Central suction systems serving medical and surgical 
functions, including controls. 

• Sump pumps and other equipment required for 
operation of safety and major apparatus, including as- 
sociated control systems and alarms. 

• Compressed air systems serving medical and 
surgical functions, including controls. 

The following equipment shall be arranged for either 
time-delayed automatic or manual connection to the 
alternate power source: 

• Heating equipment for operation rooms, delivery 
rooms, labor rooms, recovery rooms, intensive care 
units, coronary care units, nurseries, and general pa- 
tient-care rooms. 

• Elevators selected to provide service to patient 
floors, surgical suites, or obstetrical suites during inter- 
ruption of normal power. (In other elevators, where 
interruption of normal power would result in the eleva- 
tor's stopping between floors, facilities shall be pro- 
vided to allow for temporary operation, in order to 
release occupants who would otherwise be trapped.) 

• Supply and exhaust ventilating systems for surgical, 
OB, and delivery suites; infant nurseries; infection iso- 
lation rooms; emergency treatment spaces; labora- 
tories. 

• Hyperbaric facilities. 

• Hypobaric facilities. 

• Doors operating automatically. 

• Such other equipment as may be deemed necessary 
by the hospital, subject to approval of the authority 
having jurisdiction. 

• Minimal electrical heating and autoclaving equip- 
ment. 

• Other selected equipment. 

GENERAL SYSTEM REQUIREMENTS 

In all facilities, the Essential Electrical Systems shall 
have a minimum of two independent sources of power 
— the normal source, which generally supplies the main 
power for the entire electrical system, and one or more 
alternate sources for use when the normal power supply 
is interrupted. 

In most cases, the alternate source of power shall be 



a generator, located on the premises and driven by 
some form of prime mover, such as an internal combus- 
tion engine. But in nursing homes or residential custo- 
dial care facilities that do not have patients whose lives 
are sustained by electromechanical means — and that 
offer no surgical treatment requiring general anesthe- 
sia — an automatic battery-operated system is suffi- 
cient. 

NFPA 76A cautions that design of the Essential Elec- 
trical Systems should be such that simultaneous 
destruction of both normal service and the Essential 
Electrical Systems cannot occur as a result of a local 
catastrophe. In the design of these systems, considera- 
tion should be directed toward maximizing the reliabil- 
ity of the alternate power source and its feeders, rather 
than to protecting the equipment, providing protection 
is not required to prevent a greater threat to human 
life, such as explosion, electrocution, etc. 

Other factors to be considered in design are: 

• Abnormal currents that may cause interruption dur- 
ing overload. 

• Abnormal voltages, such as switching transients and 
lightning surges. 

• Capability for achieving fast restoration of power. 

• Planning for future needs. 

• Stability and power capability of the prime mover 
during and after abnormal conditions. 

• Sequencing reconnection of power loads to avoid 
large current inrushes that could trip over- current de- 
vices or overload the generators. 

Transfer switches. The number of transfer switches 
to be used should be based on reliable design and load 
considerations. Each branch of the Essential Electrical 
Systems shall be permitted to be served by one or more 
transfer switches. One transfer switch shall be per- 
mitted to serve one or more branches or systems in a 
smaller facility. 

The systems may have automatic transfer switches 
and nonautomatic transfer switches. Each switch shall 
have the capacity to supply the loads to be served. 

Automatic transfer switches shall be electrically 
operated and mechanically held. These transfer 
switches shall transfer and retransfer loads automati- 
cally. Reliable mechanical interlocking or other 
approved automatic methods shall be required for the 
automatic transfer switch and shall be inherent in the 
design to prevent interconnection of the normal and 
alternate sources of power. 

Time-delay devices may be used: 

• To delay starting the generator, in order to prevent 
nuisance tripping of the generator with transient volt- 
age drop. (The generator still must be on line within 10 
seconds.) 

• To delay transfer to the alternate power source, in 
order to prevent heavy motors from starting loads 
simultaneously. 

• To delay re-transfer to the normal power source, in 
order to allow the normal source to stabilize, and thus 



22 



U.S. Navy Medicine 



avoid the tripping of current devices by heavy loads. 

On automatic transfer switches, a test function shall 
be provided that will simulate a normal-power-source 
failure to the switch. Two pilot lights, properly 
identified, shall be provided to indicate the transfer 
switch position. A means for safe manual operation of 
the automatic transfer switch shall be provided. 

Nonautomatic transfer switches shall be mechani- 
cally held. Operation shall be by direct manual or elec- 
trical remote manual control. The electrical -operation 
switches shall derive their control power from the 
source to which the load is being transferred. 

Reliable mechanical interlocking or another approved 
method shall be inherent in the design, to prevent in- 
terconnection of the normal and the alternate sources of 
power, or any two separate systems of power. Pilot 
lights, properly identified, shall be provided to indicate 
the switch position. 

Generator sets. Generator sets installed as an alter- 
nate source of power for the Essential Electrical Sys- 
tems shall be designed to meet the requirements of 
such service. The generator equipment used shall be 
either reserved exclusively for such service or normally 
used for other purposes. If the equipment is normally 
used for other purposes, two such generator units shall 
be installed, so that demand and performance require- 
ments of the Essential Electrical Systems shall be met 
with the largest single generator set out of service. 
(Exception: A single generator shall be permitted to 
operate the Essential Electrical Systems for peak- 
demand control, internal-voltage control, or relief for 
the external utility, provided that such use will not de- 
crease the mean period between service overhauls to 
less than three years.) 

Generator sets shall be installed in accordance with 
NFPA Standard 37, "Installation and Use of Stationary 
Combustion Engines and Gas Turbines," 1975. 



Service transformers shall not be installed in the 
generator area. The generator shall be maintained in an 
appropriate temperature, and there shall be adequate 
air for cooling and replenishment of the engine-com- 
bustion air. The internal combustion starting battery 
shall have sufficient capacity to provide 60 seconds of 
continuous cranking. A compressed-air starting device 
for internal combustion engines shall have sufficient 
capacity to supply five 10-second starting attempts with 
not more than a 10-second rest between attempts. 

Fuel for the generator shall be liquid, and there shall 
be on-site fuel storage capacity. The amount of fuel 
stored on-site shall depend on past outage records, 
possible delivery problems due to weather, fuel short- 
ages in the area, and various other similar conditions. 

Safety alarm devices for the internal combustion 
engine shall be provided. Prime movers other than 
internal combustion engines, serving generator sets, 
shall have appropriate signal devices, plus visual and 
audible alarms, to warn of malfunction. There shall also 
be alarms to warn of low fuel level. 

Generator sets serving the Emergency and Equip- 
ment systems shall be inspected weekly and shall be 
exercised under load and operating temperature condi- 
tions for at least 30 minutes, at intervals of not more 
than 30 days. The 30-minute exercise period is an abso- 
lute minimum unless the manufacturer's recommenda- 
tions dictate otherwise. 

The scheduled test under load conditions shall in- 
clude a complete, simulated cold start and appropriate 
automatic and manual transfer of all Essential Electri- 
cal Systems loads. This simulated cold start and trans- 
fer of all loads is primarily needed to demonstrate the 
availability of essential power. 

A secondary benefit of the test is familiarization of 
the hospital staff with the emergency power available 
for patient care. 



Notes from the I.G., Medical 



* Linen management: To minimize 
contamination, soiled linen should 
be deposited in impervious bags or 
containers that are closed at the site 
of collection. 

• Medical record: Request for Ad- 
ministration of Anesthesia and for 
Performance of Operations and 
Other Procedures , Standard Form 
522 (Rev. 10-76), is to be used for 
evidence of the patient's informed 
consent for any procedure or treat- 
ment performed, and is to include 
the name(s) of the individual(s) who 
perform the procedure or adminis- 



ter the treatment. It has been noted 
that most hospitals and clinics are 
still using SF 522 (Rev. 1973). 

• Antibiotics: The Infection Surveil- 
lance Committee should regularly 
review antibiotic usage, both quan- 
titatively and qualitatively. 

• Medications: The metric system 
shall be in use for all medications. 

• Continuing education: The con- 
tinuing education program for per- 
sonnel in special care units must in- 
clude precautions for all electrical 
equipment in use. 

• Safety: Surgical overhead lights 



in emergency rooms, treatment 
rooms and operating rooms should 
be routinely checked for stability, 
and records of these checks main- 
tained. 

* Audit board membership: In cer- 
tain instances members of audit 
boards (collection agent, imprest 
fund, etc.) have been assigned with- 
out proper instructions or indoctri- 
nation. All commands should en- 
sure that audit board members are 
fully instructed regarding proper 
audit procedures. 

— RADM Roger F. Milnes. MC. USN 



Volume 69, June 1978 



23 



Instructions and Directives 



FY79 dental residency/graduate/fellowship 
training programs 

Residency and graduate training programs in various 
specialties are conducted at the National Naval Dental 
Center, Bethesda, Md., and at five naval regional med- 
ical centers (see chart). The number of residents in 
specific specialties may vary with current Navy regula- 
tions. 

General descriptions of residency programs are con- 
tained in NAVMED P-5093. Several modifications in 
residency and graduate training programs will be insti- 
tuted in FY79. These modifications include: 

• Two-year residency in comprehensive dentistry. Ap- 
plications for the program beginning in July 1979 at the 
National Naval Dental Center will be considered in 
September 1978. Dental officers selected will ordinarily 
continue in the second year of the program without 
having to reapply. The two-year program is designed to 
produce a trained subspecialist in all major disciplines 
of dentistry as practiced in the Navy, including endo- 
dontics, operative dentistry, oral diagnosis and oral 
medicine, oral surgery (primarily exodontia), periodon- 
tics, and prosthodontics. Comprehensive dental officers 
will be skilled clinicians whose knowledge and 
expertise in these fields, as well as in the fields of 
dental material, occlusion, patient motivation, person- 
nel management, and preventive dentistry, will qualify 
them to treat all but the most complex cases requiring 
the services of a board -eligible /certified specialist. 
These officers will be prepared for positions of greater 
clinical responsibility within the Navy Dental Corps. A 
research project is performed during this residency. 
Satisfactory completion of this residency leads to eligi- 
bility for the proposed Tri-Service Comprehensive 
Dentistry Board Examination and Certification. 

• One-year graduate training in general clinical dentis- 
try. Applications for the program beginning in July 
1979 at the National Naval Dental Center will be con- 
sidered in September 1978. This program is designed 
primarily for dental officers with 7 to 10 years of clinical 
experience who wish to develop a high degree of profi- 
ciency in all disciplines in the practice of general clini- 
cal dentistry in the Navy. The curriculum is designed to 
update the dental officer's professional knowledge by 
integrating biomedical sciences with clinical practice. 
To a lesser degree, the curriculum includes basic 
sciences, theory, dental research, naval dental adminis- 
tration, management, and leadership. The goal of this 
graduate course is to improve the clinical proficiency of 
the general dentist and better enable dental officers to 



INSERVICE TRAINING CAPABILITY 


SPECIALTY 


TRAINING SITES AND KUHBER OF BILLETS 




KKDC * 


NAVAL fc£C?£N*L UeCjCAL CEhTEHS 




SJTHtsCJ. 


G^EAT 


QA.KLMS] 




TOTAL 


ORAL PATHOLOG* 
1st year 


1* 












1* 


iHDCBflNTiCS 
lit year 














3 


2nd year 














3 


ORAL MEDICINE 
1st year 














1 


2nd year 














1 


ORAL SURGERY 
1st year 




1 


1 


| 


1 


2 


G 


2ni vear 




1 


1 


1 


1 


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3rd year 




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1 


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'.?.: year 


* 












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■ 


PROSTHOtJQNTICS 
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* 


2nd year 


6 












6 


HAXILLO-FACIAL 
Optional 
3rd year 


I* 












1* 


COMPREHENSIVE 
OEWTISTRY 
1st year 


5 












5 


Int year 


5 












5 


GENERAL CLINICAL 
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1 year 


9 












5 


OPERATIVE 
1st year 


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*The total training program billets for Bethesda Is AE, The oral pathology 
and raaxMlo-f»clal billets alternate with other training program billets. 



provide support to Fleet and Marine Corps personnel 
and other authorized beneficiaries. 
• Two-year residency in operative dentistry. This pro- 
gram will be initiated at the National Naval Dental 
Center in July 1979. Applications for the program will 
be considered in September 1978. 

NAVMED P-5093 contains a detailed description of 
inservice postdoctoral fellowship programs. It is antici- 
pated that a limited number of applications will be ap- 
proved for periodontics and research fellowships in 
FY79. 

A limited number of positions are available to Navy 
Dental Corps officers for specialty training in civilian 
institutions. Outservice training is utilized to provide 
required training in those specialties where no inser- 
vice training program is available or where inservice 
capabilities are insufficient to meet requirements. 

Applications for programs that commence during 
FY79 should be submitted by 1 July 1978 to the Com- 
manding Officer, Naval Health Sciences Education and 
Training Command (Code 5), National Naval Medical 
Center, Bethesda, Md. 20014. MANMED art. 6-129 
gives details on preparing applications. Applicants 
will be notified of the action taken on their requests 



24 



U.S. Navy Medicine 



during October 1978.— BUMED Notice 1520 of 27 Feb 

1978. 



Medical gas systems 

The press has reported that some deaths of patients 
have occurred as a result of cross-connection of medical 
gas pipeline systems. A common thread in each of 
these incidents was failure to check content of the 
pipeline systems at the station outlet. 

• NFPA 56F, Standard for Nonflammable Medical Gas 
Pipeline Systems (NOTAL), requires that all pipelines 
systems be checked for gas content after installation. 

• NAVF AC Guide Specification TS-15403 of April 1977 
(NOTAL) requires not only that the content of the gas 
be checked, but also that the gas be checked for impuri- 
ties such as hydrocarbons, particulate matter, water, 
and carbon monoxide. 

• NFPA 56A, Inhalation Anesthetic (NOTAL), requires 
that each anesthesia machine be checked at the com- 
mon gas outlet for appropriate continuity of medical gas 
systems after each repair. 

The commanding officer shall ensure that — in addi- 
tion to the tests required by NFPA 56F — after installa- 
tion of new piping systems or repair of existing piping 
systems, each station outlet of the gas piping system is 
analyzed for the appropriate gas. Samples of gas shall 
also be tested for specified contaminants, by methods 
designated in this instruction. A piping system shall be 
considered unlikely to contribute contaminants to the 
gas it transports, providing that a sample of gas from 
an outlet (a) does not have a noticeable odor different 
from that of the major component of the sample, (b) 
does not have a higher contaminant level than specified 
in this instruction, or (c) has a higher contaminant level 
than specified in this instruction, but no higher than 
that found in a sample of gas taken from the source. 

The chief of anesthesia at each medical treatment 
facility shall ensure that when new anesthesia 
machines are delivered or existing anesthesia machines 
are repaired, the common gas outlet efflux is tested for 
the appropriate gas as described in NFPA 56A, Appen- 
dix F. 

The tests and analyses required by this instruction 
shall be performed by qualified personnel. Records of 
tests and analyses required for gas piping systems shall 
be retained for two years, while records of those re- 
quired for anesthesia machines shall be retained until 
the next repair. — BUMED Instruction 10330.2 of 3 
March 1978. 



FY79 medical residency/fellowship 
training programs 

Accredited residency training programs are con- 
ducted at naval regional medical centers and other 
Medical Department facilities in 32 specialties/sub- 
specialties (see chart below). A limited number of 
positions are available to Navy Medical Corps officers 
for specialty or subspecialty training in civilian institu- 
tions. Outservice training is utilized to provide required 
training in those specialties where no inservice training 
program is available. 

Applications should be submitted by 15 Aug 1978 to 
the Commanding Officer, Naval Health Sciences Edu- 
cation and Training Command (Code 4), National Naval 
Medical Center, Bethesda, Md. 20014. BUMED In- 
struction 1520. 10G gives details on preparing applica- 
tions. Applicants will be notified of the action taken on 
their requests during October 1978. — BUMED Notice 
1520 of 1 May 1978. 



RESIDENCIES/FELLOWSHIPS TN NAVAL fl 
TEAR LEVEL 


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Endocrinology & 
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Volume 69, June 1978 



25 



Professional 



Alcoholism: Family Illness-Family Therapy 



Pat Barnett 



CDR Leslie C. Ellwood, MC, USN 



A major goal of the Navy Medical Department is to 
seek out, identify, and rehabilitate Navy and Marine 
men and women who are alcoholics or "problem 
drinkers" and return them to good emotional health 
and full work productivity. 

Excellent treatment for alcoholics is provided by 
carefully conceived rehabilitation programs at naval 
alcoholic treatment centers and units, a referral net- 
work of recovered Navy and Marine Alcoholics and 
supporting professionals , and Alcoholics Anonymous 
groups on shore and at sea. But is that enough? 
What about the emotional needs and maladaptive 
defenses that develop in members of the alcoholic's 
family? Should not our mission also include the 
necessary therapy for these other victims of alcohol- 
ism, the family disease? 

The Norfolk Naval Alcohol Rehabilitation Center 
(ARC) opened some five years ago. In the beginning, 
its staff —like those of most Navy alcohol rehabilita- 
tion facilities— bent their efforts towards helping the 
alcoholic, not the sick family. Four years ago, CAPT 
Joseph A. Pursch, MC, USN, describing the pro- 
gram of the Navy Alcohol Rehabilitation Service, 
Long Beach, Calif . , noted that ' 'wives are involved in 
the rehabilitation process wherever practical [em- 
phasis added] in order for them to understand how 
the disease has affected the family and how to cope 
with the problems" (Naval Aviation News, March 
1974, pp 8-17). 

But as more experience in rehabilitation programs 



Mrs. Barnett is a family counselor at the Alcohol Rehabilitation 
Center, Naval Station, Norfolk, Va. 23511. CDR Ellwood is a 
pediatrician in the Pediatrics Department, ADM Joel T. Boone 
Clinics, Little Creek Amphibious Base, Norfolk, Va. 23521. 



has been gained, the problems of concerned persons 
— the spouses and children of alcoholics— have been 
increasingly recognized, and the need for family 
therapy has become obvious. The resources to pro- 
vide such treatment remain limited; however, ARC 
Norfolk has accepted the challenge and has devised a 
workable program. It is our belief that a similar com- 
mitment to the Navy alcohol program by all person- 
nel of the Medical Department could produce multi- 
disciplinary teams , coordinated by alcohol rehabilita- 
tion facility staffs, that would broaden the scope and 
effectiveness of assistance available. 

REASONS FOR FAMILY THERAPY 

There are numerous benefits from family therapy 
in alcohol rehabilitation. It not only provides appro- 
priate treatment for concerned persons but also 
significantly improves the outcome of the alcoholic's 
therapy. Often, as a result of the family program, the 
alcoholic will voluntarily seek help from Alcoholics 
Anonymous or the Navy treatment system because 
he has observed that his family has begun its own 
recovery. This ear her start in the alcoholic's recovery 
frequently averts work problems or need for discipli- 
nary action. Additionally, total family involvement 
provides optimum success rates, many times higher 
than those for nonparticipating families. 

Janzen (1) listed several other advantages perti- 
nent to Navy programs, including the following: 

• The percentage of patients attaining sobriety in- 
creases in proportion to contacts with the clinic by 
concerned persons. 

• The family program reduces the total cost of re- 
habilitation and, if offered while the alcoholic is an 



26 



U.S. Navy Medicine 



inpatient, increases the likelihood that he or she will 
continue treatment as an outpatient. 

• The alcoholic is less likely to regard himself as a 
"mental patient," since the family group is being 
treated. 

• Alcoholics perceive their spouses' involvement as 
an expression of caring about them, and this in- 
creases their motivation. 

• The program stimulates improvement of com- 
munication between alcoholic and spouse. 

• The spouse's involvement requires and prepares 
the alcoholic to face discharge realities more 
directly, and allows for exposure and resolution of 
marital conflicts. 

If we accept the idea that the concerned person 
also has the illness of alcoholism, then we must pro- 
vide relief from the illness. Steyn {2) has stated that 
' 'helping an alcoholic reach sobriety without involv- 
ing the family often renders the spouse severely ill, 
and you only transfer the malady from one family 
member to another." 

Attempts to treat concerned persons' mental and 
psychosomatic pain in medical, surgical, emergency, 
pediatric, and gyn clinics, with laboratory tests, in- 
adequate therapy, and tranquilizers, are obviously 
less beneficial than an effective program directed to 
the primary problem: alcoholism, the family illness. 

As to the effects of parental alcoholism on chil- 
dren, living in an alcoholic family places the child in 
the high-risk category for school ana behavioral 
problems ; psychosomatic illness secondary to stress ; 
delinquency; drug abuse in adolescence (3) ; and, for 
children of the same sex as the alcoholic parent, sub- 
sequent alcoholism. At least 50 percent of the wives 
in our therapy groups are from alcoholic homes, and 
approximately one out of every twenty report being 
raped by drunken fathers or stepfathers. 

To use the example of another disease, we do not 
allow active-duty sailors with active tuberculosis to 
remain in the home, but first provide specific 
therapy to the sick patient until he is no longer infec- 
tious; evaluate and skin-test the family; and provide 
specific therapy and followup for identified skin-test 
convertors. Alcoholism kills or injures many more 
people among service personnel and their families 
than does tuberculosis. The implication of these 
statements should be obvious. 

FAMILY THERAPY AT ARC NORFOLK 

The family program developed at the Norfolk 
Naval Alcohol Rehabilitation Center provides group 
and individual counseling for the spouse of the ARC 



patient; anonymous group counseling for wives of 
practicing alcoholics; instruction in marriage and 
parenting skills for patients and their spouses; 
pediatric evaluation and group and individual coun- 
seling for children of alcoholics; and referrals for 
appropriate therapy in cases of child abuse or wife 
abuse. This broad range of services has been effec- 
tive in treating concerned persons' pain and illness, 
in providing information about family dynamics to 
persons with inadequate family-experience imprint, 
and in significantly enhancing the effectiveness of 
therapy for the alcoholic. 

Staff for the family program consists of one full- 
time family counselor and five volunteers who have 
gone through the program themselves and have 
been trained in interviewing patients and lecturing 
on aspects of alcoholism as a family disease. The 
benefit of having such volunteers is their first-hand 
knowledge of the problems and the recency of their 
experience with them. 

Spouses of patients entering ARC are interviewed 
and individually counseled about the patient's 
alcoholism, their own role in the family illness, and 
the Al-Anon program. Only extreme distance of the 
spouse from the ARC , or a legal separation prepara- 
tory to divorce , precludes concerted Command effort 
to obtain the spouse's participation in the family pro- 
gram. 
It is our philosophy that for most successful resolu- 
tion of the problem the alcoholic's spouse should 
recover at the same time as the patient. The spouse 
attends two full days of group education and counsel- 
ing sessions a week, for six weeks, during the same 
period that the alcoholic is a patient at the ARC. 
(Babysitting, if needed, is available at the Base 
nursery.) The group has as its therapeutic goals 
education about alcoholism ; introspection and exam- 
ination of the spouse's own personality; preparation 
for the problems of the recovery phase, after the pa- 
tient's discharge from the ARC; and counseling 
about the possibility of the patient's return to active 
alcoholism. (Alcoholism is a chronic relapsing dis- 
ease, and statistics show that three out of every ten 
alcoholic patients will return to destructive drink- 
ing.) 

The spouses' educational program includes films; 
reading; and discussion of the "Big Book" by the 
founder of Alcoholics Anonymous, other books on 
alcoholism and recovery, and Al-Anon publications. 
The spouses are instructed in the Twelve Steps and 
Twelve Traditions of the Al-Anon family programs 
and are expected to attend Al-Anon meetings in the 
community. 



Volume 69, June 1978 



27 



The need for the concerned person to make major 
life adjustments as the alcoholic recovers is con- 
stantly stressed. When the spouse does not have a 
recovery program and the alcoholic recovers, the 
spouse loses the positions of controller, martyr, and 
enabler. Divorce becomes more likely, in the first to 
third year of sobriety, as a result of the change in the 
previous relationships. Feelings of desertion ("He 
might as well be drunk"), resulting from the alco- 
holic's frequent attendance at A A meetings and 
heavy involvement with other alcoholics, must also 
be resolved. 

In addition to the program for patients' spouses, 
ARC Norfolk provides a treatment group for wives of 
practicing alcoholics who are not in rehabilitation 
therapy. This six-week program is available com- 
pletely anonymously and is similar in content to the 
program described above. For most of those 
enrolled, it provides their first experience with 
having someone else care about them and their prob- 
lems and needs. 

The treatment group promotes stabilization of the 
family and improved mother-child dynamics, in spite 
of the alcoholic's continued illness. The spouses 
learn that their alcoholic partners must obtain care 
for their illness themselves. Spouses are taught to 
disentangle themselves from outside influences that 
tend to perpetuate the alcoholic's rationalization for 
destructive drinking. Although it is not the intent of 
the treatment group to coerce or manipulate the 
alcoholic into therapy, withdrawal of the spouse's 
inadvertent support of the alcoholic's drinking pat- 
terns frequently causes sufficient crisis to prompt 
some 50 percent of alcoholics to seek help through 
the ARC or Alcoholics Anonymous. 

ARC provides a weekly support group for spouses 
who wish to continue in group therapy indefinitely, 
after the alcoholic has been discharged. Prerequi- 
sites for admission to this group are attendance of 
the six- week program previously described and par- 
ticipation in Al-Anon. The material covered varies 
with the needs of the individuals enrolled. The style 
is confrontive and supportive, and promotes personal 
growth. 

For the past two years, with the cooperation of the 
Department of Pediatrics at NRMC Portsmouth, 
ARC Norfolk has provided therapy for the children of 
alcoholics . 

Initial interviewing of concerned-person parents 
includes a questionnaire to screen for potential to 
abuse children, and families with such problems are 
referred to child advocacy committees for evaluation 
and counseling. 



ARC patients' children who are more than seven 
years old are expected to attend Alateen meetings. 
These meetings help the child resolve his anger and 
resentment toward the alcoholic and the other parent 
by teaching him that both parents are ill, that he 
must be responsible for himself only, that he must 
stop enabling the alcoholic parent's drinking, and 
that he is not responsible for the alcoholic disease. 

During rehabilitation therapy, alcoholic parents 
receive two lectures— followed by group discussion, 
led by a pediatrician or a pediatric nurse practitioner 
—on the effects of alcoholism on their children, child 
development, appropriate expectations of the child, 
and methods of child rearing. Most of these patients 
have ineffective relationships with their children and 
are most eager to develop parenting skills. Fre- 
quently, although parenting techniques are lacking, 
love is not. 

Individual counseling for specific behavior prob- 
lems (with the role of alcoholism always included in 
the discussion) is readily available to patients on 
request. 

Recently, ARC Norfolk initiated an adolescent 
group (ages 11 to 15) and a children's group (ages 5 
to 10)— both conducted by a pediatrician and a pedi- 
atric nurse practitioner at Boone Clinic*— to provide 
more goal-directed therapy than is offered by 
Alateen. The groups were established for children of 
ARC patients with spouses enrolled in the family 
program. The children 8 years of age or older in 
these groups are expected to attend Alateen as well. 
A similar program for children of newly identified 
alcoholic families is held at the ARC by the staff psy- 
chologist. 

Absence of effective communication between 
parents and adolescents, inability to express emo- 
tions, and self -destructive behavior are common 
problems found among these children. Through 
group interaction, they learn and practice self-evalu- 
ation, communication, appropriate expression of 
emotional needs, and parent-child conflict resolu- 
tion. 

One more aspect of the ARC programs should be 
mentioned. It has been noted that the percentage of 
patients under age 25 who achieve sobriety is low, 
and that the percentage of these patients who come 
from alcoholic families is very high. These young 
alcoholics are, in fact, also still acting out the stress 
of their own childhood in an alcoholic family. In a 
"youth group" for this class of patient, therapy is 



'The co-author, CDR Ellwood, and LT Tina Grant, NC, USN 



28 



U.S. Navy Medicine 



specifically oriented toward treatment of their status 
as products of an alcoholic family. This treatment of 
another facet of their illness aids recovery. 



ered at ARC Norfolk, which would like to see addi- 
tional family programs initiated and help develop a 
Navy-wide effort to provide this vital care. 



CONCLUSION 

Alcoholism is the major chronic problem of the 
active-duty Navy and Marine community, and is also 
a significant problem of the dependent population. 
Not only alcoholics but concerned persons— spouses 
and children— need and deserve appropriate ther- 
apy. Such family therapy is being effectively deliv- 



REFERENCES 

1. Janzen C: Families in the treatment of alcoholism. J Stud 
Alcohol 38(1):114-131, 1977. 

2. Steyn RW: Drink, doctors, and seadogs. US Nav Med 
67(7):24-29, 1976. 

3. Spevack M, Pihl RO: Nonmedical drug use by high school 
students: a three-year survey study. Int J Addict ll|5):755-792, 
1976. 



BUMED SITREP 



TRAINING OPPORTUNITIES . . . Pre 

ventive dentistry/public health training 
opportunities exist for dental officers 
who wish to assume additional responsi- 
bilities in total preventive health plan- 
ning as well as take part in the other 
clinical disciplines. For additional infor- 
mation, contact CDR Sanford A. Glazer, 
DC, USN, Head, Preventive Dentistry 
Section, BUMED Code 6114, Washing- 
ton, D.C. 20372. Telephone: Commer- 
cial (202) 254-4283; Autovon 294-4283. 

HYPERBARIC 2 TREATMENT ... At 

the National Naval Medical Center, 
dental and medical investigators have 
completed a four-year, controlled, 
double-blind study of hyperbaric oxygen 
treatment of the chronic bone infection 
osteoradionecrosis. 

One hundred percent oxygen therapy 
administered at two atmospheres (hy- 
perbaric) was found to be more effective 
than 100 percent oxygen at one atmos- 
phere (normobaric). Patients under- 
going hyperbaric therapy were relieved 
of their severe pain, and other overt 
symptoms of infection — such as puru- 
lent drainage — were markedly dimin- 
ished. 

NOISE MONITORING . . . High-inten- 
sity noise levels in dental facilities will 
be monitored by BUMED to ensure 
preservation of hearing acuity in dental 
officers, technicians, civilian dental 
hygienists, and assistants. Monitoring 
will begin during the current fiscal year. 

CEARP MANUAL ... The Navy Nurse 
Corps Continuing Education Approval 



and Recognition Manual was revised in 
February and is being distributed to 
Medical Department facilities where 
Nurse Corps officers are serving. The 
manual gives guidelines for planning 
and implementing continuing education 
programs and submitting them for ap- 
proval. It also outlines the criteria on 
which approval is based. 

Applications for approval of continu- 
ing nursing education programs or of- 
ferings should be forwarded to the Com- 
manding Officer, Naval Health Sciences 
Education and Training Command 
(HSETC), Code 7, National Naval Medi- 
cal Center, Bethesda, Md. 20014, fol- 
lowing procedures set forth in the 
CEARP Manual. 

Questions about CEARP may be ad- 
dressed to the Director, Nurse Corps 
Programs, at the above address; tele- 
phone: Autovon 295-0630; Commercial 
(202) 295-0630. 

AUDIT TIPS . . . Activities generally 
have adequate instructions covering 
timekeeping and civilian payroll proce- 
dures but have not sufficiently moni- 
tored implementation of the procedures. 
With the issuance of SECNAV Instruc- 
tion 7510.8 of 15 Oct 1976, Internal 
Review was given a new thrust and 
dimension within the Department of the 
Navy. The Internal Review function in- 
cludes an annual audit of timekeeping 
and civilian payrolls. . . . The following 
discrepancies were noted on a recently 
completed audit: • Revise the Basic 
Facilities Requirements List to comply 
with the criteria of NAVFAC P-80, as 
required by NAVFACINST 11010.44B; 



• Conduct semiannual walk-through 
inspections, in accordance with BU- 
MEDINST 6700.37. 

UCA IMPLEMENTATION . . . Imple- 
mentation of the DOD Medical Treat- 
ment Facility Uniform Chart of Ac- 
counts (UCA) is continuing at four Navy 
test sites. The first Military Expense 
and Performance Reports (MEPR) were 
received from the test sites in late 
February of this year. These quarterly 
reports are designed to provide a 
common standard of expense and per- 
formance measurement that will allow 
any military medical treatment facility 
to be compared with its counterpart in 
another military department or the civil- 
ian sector. A data-processing capability 
to produce the MEPR and other cost- 
finding reports is currently under devel- 
opment. Its goal is to minimize the 
impact on the services and provide 
timely, accurate reports. Full, world- 
wide implementation of the UCA re- 
mains scheduled for 1 Oct 1979. 

SMOKING REPORT . . . The Smoking 
Digest — Progress Report on a Nation 
Kicking the Habit is a 127-page booklet 
designed as a tool for public education. 

The report summarizes current 
knowledge of smokers' attitudes and 
practices, biomedical effects of smok- 
ing, programs to help smokers rid them- 
selves of the habit, etc. 

Copies of The Smoking Digest are 
available free to health planners and 
professionals. Write the Office of Can- 
cer Communications, National Cancer 
Institute, Bethesda, Md. 20014. 



Volume 69, June 1978 



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